Systemic Illnesses That Cause Movement Disorders
The CNS control systems of the motor behavior reside in a very complex and highly organized network of neuronal circuits implying extremely numerous synaptic connections and interrelations among cortical and subcortical structures, allowing a very complex
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Ovidiu A. Bajenaru
As the brain network of circuits related to the cortical and subcortical structures involved in the control of motor behavior is structurally and functionally extremely complex, implying a multisynaptic activity and an intracellular metabolic signaling system using multiple biochemical pathways, its vulnerability to various pathogenetic mechanisms related to many of the systemic diseases with CNS involvement is increased. This vulnerability is related to both structural lesions and biochemical alterations, and the large variability of systemic diseases and their particular mechanisms explain why different movement disorders, among chorea and dystonia, are probably the most frequent [1], being part of the clinical symptomatology of these diseases, usually in association with other neurological and specific non-neurological symptoms suggestive for a particular etiology. In this review, we shall try to describe in a concise and systematized manner these abnor-
O.A. Bajenaru, MD, PhD Department of Neurology, University Emergency Hospital Bucharest, 169, Splaiul Independentei, sectorul 5, Bucharest RO-050098, Romania Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania e-mail: [email protected]
malities related to the most frequent systemic diseases, grouped in etiologic categories.
43.1 Infectious Diseases 43.1.1 HIV Infection Neurological disorders associated with HIV infection are due to lesions which may appear at all levels of both central and peripheral nervous system, in all stages and forms of the disease (both the primary HIV-associated illness and the secondary neurologic complications determined by immunosuppression as the opportunistic infections – toxoplasmosis, tuberculosis, cryptococcosis, syphilis, progressive multifocal leukoencephalopathy, or primary lymphoma of the CNS). In particular, in HIV encephalopathy the basal ganglia have a particular susceptibility, probably because of the high density of microglia (those cells infected by the virus, which mediate subsequent neuronal death) and due to the intrinsic properties of the neurons in this brain area [2]. In rare cases, spinal myoclonus has been associated with HIV infection [3]. Also the secondary effects of some of the specific drugs used in the current era of HAART may contribute to some clinical particularities of the secondary movement disorders that might become apparent in this illness. Not only parkinsonism and dystonia but also chorea–ballismus, myoclonus, tremor,
© Springer-Verlag Wien 2017 C. Falup-Pecurariu et al. (eds.), Movement Disorders Curricula, DOI 10.1007/978-3-7091-1628-9_43
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akathisia, neuroleptic malignant syndrome, oculomasticatory myorhythmia (associated with Whipple’s disease), and paroxysmal dyskinesias have been reported in HIV-infected patients [1, 4–16]. Also tardive dyskinesia may be seen in these patients [17]. Drug interactions with ritornavir, indinavir, and risperidone have been related to th
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